Feedback Loops: Why Doctors Write Stupid Things on the Internet

The warm weather has finally arrived, and the heat and humidity has just enrolled half your city into the Guns and Knives club. It seems like all the local news is reporting on the horrific violence and alarmingly increasing rates of crime. Everyone is talking about it, including the staff, physicians, and EMS who work in the ED... Trauma code is sounded overhead, you rush over to the resuscitation bay and see the most gruesome facial trauma victim ever. You reach into your pocket, pull out your phone and snap a quick shot... Before the trauma surgeon can ask for the results of the primary survey, your photo is uploaded to Facebook. By the time you make it home after your shift, your photo has garnered 15 “likes” and 10 comments.

Facebook made me do it
A NY Times article from June 2013, ironically titled “Facebook made me do it”, attempted to answer the question of why otherwise intelligent professionals post inappropriate things online. Simply put, we want feedback. Social media sites create a feedback loop that positively reinforces the emotions we experience. For example, ED physicians are often exposed to horrific stories of violence against people. These experiences can have a lasting impact and be damaging to the psyche. People post onto social media sites to express the complex emotions they feel both as physicians and as humans. It can be comforting to know that others in the social circle may have also had a similar experience. Or it may feel affirming to know that despite the awful experience, people still think of the poster as an excellent doctor. As a result, the person may feel a little better after a difficult patient encounter. The social media site not only became a tool to vent, but also a tool to provide emotional comfort. This encourages the person to post again in the future after experiencing another highly charged situation. Thus the positive feedback loop is created.

Feedback loops aren’t the problem, per se. Nobody is an island and emotions need to be expressed. That is what resident wellness committees try to address. This is why coping strategies are taught through stress management seminars. The issue is the platform. Social media is not the place to seek positive feedback, especially when it shares patient information and degrades professionalism.

Common Mistakes
One common mistake that doctors make is thinking that their posts are more private than they are. Unfortunately the internet is a free for all and any information you post is easily accessed and can easily be made “viral” overnight. It is important to consider when posting anything whether that material is appropriate for the entire world to see, including the CMO of the hospital.

Another trap of social media is its 24-hour access and instant gratification. When the barrier to post online is incredibly low (just a couple clicks away on your smartphone), we’re likely to fire off a status update in the midst of feeling particularly emotionally charged. Writing out thoughts can be therapeutic. However, it may be better to pause after writing and wait a few hours until perspective can be developed on the situation. Perhaps the snarky comment on the nasty patient that was encountered the night before may no longer seem witty and will actually appear to be more of a patient privacy violation. (P.S. This same advice holds true when dealing with relationship break ups!)

The final trap is that of the commenters culpability. It would be a mistake to think that physicians only need to worry about what they themselves post online. The “social” aspect of the “social media” implies the sharing of materials for others to consume, which we express through comments, “likes,” and views. When we show support for a colleague by “liking” an inappropriate post, we are endorsing the original material, and indicting ourselves in the process.

Clearly, emotions and feelings need to be expressed. Emergency medicine can be a high stress environment which does take a toll upon those working in the field. That’s why we need friends, family – and happy hour. But while social media sites have held out the promise of community support, they lack the privacy necessary to create a safe space. Professionals feel that they can vent and receive support from friends, but the veil of intimacy is only an illusion. Be smart. By knowing how the system encourages over-sharing, doctors can be savvy enough to avoid costly mistakes.

Dr. Nikita K. Joshi (@njoshi8) is an academic fellow at Stanford University

Comments

Excellent article, Niki! Social media has created a culture of complete transparency of people's lives and feelings. I completely agree that often people, including physicians post comments in order to validate their feelings. This is why there needs to be social media policies that are explicit in stating what is professional, and what's not; despite most of it being common sense.